Coxsackievirus A16 (CA16), which primarily causes hand, foot, and mouth disease (HFMD), is associated with complications, such as encephalitis, acute flaccid paralysis, myocarditis, pericarditis, and shock. However, no case of pancreatitis associated with CA16 has been reported in children. We report a case of CA16-associated acute pancreatitis in a 3-year-old girl with HFMD. She was admitted because of poor oral intake and high fever for 1 day. Maculopapular rashes on both hands and feet and multiple vesicles on the soft palate were observed on physical examination. She was treated conservatively with intravenous fluids. On the fourth hospital day, she had severe abdominal pain and vomiting. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28–100 IU/L; lipase, >1,500 IU/L; reference range, 13–60 IU/L), and ultrasonography showed diffuse swelling of the pancreas with a small amount of ascites. The real-time reverse transcription polymerase chain reaction result from a stool sample was positive for CA16. CA16 can cause acute pancreatitis, and should be considered in the differential diagnosis of abdominal pain in children with HFMD.
Abdominal Pain ; Amylases ; Animals ; Ascites ; Child ; Child, Preschool ; Diagnosis, Differential ; Encephalitis ; Exanthema ; Female ; Fever ; Foot ; Foot-and-Mouth Disease ; Hand* ; Hand, Foot and Mouth Disease* ; Humans ; Lipase ; Mouth Diseases ; Myocarditis ; Palate, Soft ; Pancreas ; Pancreatitis* ; Paralysis ; Pericarditis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Reverse Transcription ; Shock ; Ultrasonography ; Vomiting

Regular exercise and a certain level of physical activity reduce the mortality rate in the elderly. The purpose of this study was to investigate the effect of physical activity on the prevention of fracture in the middle aged or older in Korea. The basic data are based on the Ansan and Ansung community cohort studies of the Korean Genome and Epidemiology Study conducted by the Korea Centers for Disease Control and Prevention in 2001, and the fracture data from the third survey in 2005 to the sixth survey in 2011. The physical activity of the aged in the 40s was mostly distributed in the World Health Organization (WHO) recommended range of 7.5 to 30.0 metabolic equivalent·hr/wk, and the activity was gradually divided into the low and high groups in the 50s and 60s. In the 60s, the risk of fracture was reduced to 0.63 times compared to that of the 50s when physical activity was the recommended level (odds ratio, 0.63; p<0.001). For Korean adults, there was no significant difference in fracture incidence according to the amount of physical activity in the middle-aged people. However, for the elderly aged 60 and over, the risk of fracture decreased when the WHO recommended level of activity was performed, and the risk increased when less or more activities were performed.
Adult* ; Aged ; Centers for Disease Control and Prevention (U.S.) ; Cohort Studies* ; Epidemiology ; Fractures, Bone ; Genome ; Gyeonggi-do ; Humans ; Incidence ; Korea ; Middle Aged ; Mortality ; Motor Activity* ; World Health Organization

BACKGROUND: Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 microg), and to identify factors associated with efficacy. METHODS: A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. RESULTS: A total of 370 patients were included in final analysis. The median BMD was 0.81 +/- 0.12 g/cm2 at pre-treatment and 0.84 +/- 0.13 g/cm2 after one year. The average BMD improvement was 3.4% +/- 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. CONCLUSION: Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy.
Abdominal Pain ; Absorptiometry, Photon ; Alendronate ; Bone Density ; Calcitriol ; Calcium ; Compliance ; Drug Combinations ; Female ; Humans ; Osteoporosis ; Osteoporosis, Postmenopausal ; Physicians, Family ; Social Class ; Spine ; Surveys and Questionnaires